Update on scapular fractures

About 3-5% of all fractures of the shoulder girdle affect the scapula. The high energy required to fracture the scapula often leads to injuries of other regions of the body such as the thorax. The scapula can be divided into at least four anatomical regions with individual fracture classifications. Bony and soft tissue structures together form the superior shoulder suspensory complex (SSSC). For diagnostic imaging, three-dimensional reconstruction of the fracture based on computed tomography data enables optimal treatment planning and preparation for surgery. In the diagnosis of scapular injuries, neurological assessment of concomitant injuries to the brachial plexus must be considered. Each injury must be analyzed and addressed individually when selecting the appropriate treatment, focusing on the expected functional outcome of the patient. The decision-making process can be objectified using measurement parameters such as the glenopolar angle or other parameters regarding dislocation or instability. Pseudarthrosis rates are relatively low due to good vascularization and soft tissue coverage and conservative treatment should be preferred for nondisplaced fractures. Surgical treatment options include open osteosynthesis as well as arthroscopically assisted procedures. Sometimes, two-staged procedures from anterior and posterior are required. Decision-making is complex and as injury incidences are low individual experience is often limited; thus, treatment in dedicated centers should be discussed.